Faculty Bibliography

Health insurance plans that include coverage for out-of-network providers are common and have the potential to reduce health care costs and even improve quality. Yet, consumers may be exposed to significant unexpected and unreasonable out-of-pocket costs due to lack of accurate information on network participation, nontransparent out-of-pocket costs, inadequate provider networks, involuntary use of out-of-network emergency care, and use of out-of-network providers at in-network hospitals. Although the Affordable Care Act and some states provide some consumer protections, these may not be adequate.

We examined health literacy and health care spending and utilization by linking responses of three health literacy questions to 2006 claims data of enrollees new to consumer-driven health plans (n = 4,130). Better health literacy on all four health literacy measures (three item responses and their sum) was associated with lower total health care spending, specifically, lower emergency department and inpatient admission spending (p < .05). Similarly, fewer inpatient admissions and emergency department visits were associated with higher adequate health literacy scores and better self-reports of the ability to read and learn about medical conditions (p-value <.05). Members with lower health literacy scores appear to use services more appropriate for advanced health conditions, although office visit rates were similar across the range of health literacy scores.